Frequently Asked Questions
§ 9789.12.11 Evaluation and Management: Coding - New Patient; Documentation
A guide to billing for evaluation and management (E/M) services for new patients, complete with links to the necessary regulatory information and detailed instructions
In section 9789.12.11, the California Division of Workers’ Compensation (DWC) separately defines and distinguishes:
- new patients, and
- established patients.
New Vs. Established Patient
- A “new patient” is one who is new to the physician or medical group or an established patient with a new industrial injury or illness. Only one new patient visit is reimbursable when billing for the same incident, injury or illness.
- An “established patient” is a patient who has been seen previously for the same incident, injury or illness.
Section 9789.12.11 also establishes the required guidelines for Evaluation & Management Services. For Evaluation & Management services, physicians and qualified non-physician practitioners must use either:
- the “1995 Documentation Guidelines for Evaluation & Management Services,”
- or “1997 Documentation Guidelines for Evaluation and Management Services.”
California Code of Regulations (CCR)
Division of Workers’ Compensation Websites
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